Kiwiology

Any Fire Service involvement should be limited to confirmed cardiac arrests (nine echo). Omega cat calls get a response? Not here they don't!

Outer Front Pocket (Upper) 1 x Stethoscope 1 x Blood glucose meter & test strips 1 x B/P cuff Adult 1 x B/P cuff Child 1 x Pupil torch 1 x Clothing shears Outer Front Pocket (Lower) 1 x Suction c/w Adult & Child fittings (optional) 1 x Safety glasses 1 x Sharps container 2 ea N95 & surgical masks Outer Large Side Pocket 1 x Glucose 10% / 500ml 1 x 50ml syringe & drawing-up needle 1 x Carrero oral glucose 1 min Glucagon 2 x Emesis containers Outer Small Pocket (Lower) 1 x CAT (combat action tourniquet) 3 x Combine dressings (20cm x 30cm) 6 x Sterile gauze squares (75mm x 75mm) 6 x 30ml saline (irrigation) Outer Small Pocket (Upper) 1 x Environmental blanket 2 x Crepe bandage 1 x 5cm tape Durapore (or similar) 1 x 2.5cm tape Durapore (or similar) 2 x Steristrips 3 x Triangular bandages Inside Pocket (Upper) 1 x Cricothyroidotomy kit 1 x Intraosseus device 1 x Turkel Chest drain device & Betadine wipes 1 x Disposable scalpel & blade Inside Pocket (Middle) 1 ea Oropharyngeal Airways sizes 000– 4 1 ea Nasopharyngeal Airways sizes 6.5, 7.5, 8.5 1 x Lubricant Base - LMA Kit 1 ea Laryngeal mask airways sizes 1,2,3,4,5 1 x Paediatric Thomas tube holder 1 x Adult Thomas tube holder 1 x 50 ml syringe 1 x Lubricant (optional) 1 x Cobb connector (optional) Inside Pocket (Lower Left) 10 x Salbutamol 2.5mg / 2.5ml 1 x Nebuliser 1 x Nebuliser mask Adult 1 x Nebuliser mask Child 1 x Oxygen tubing (optional) Inside Pocket (Lower Right) 1 x Paracetamol tabs (sheet) 6 min Ondansetron wafers (4mg) 1 x Methoxyflurane kit 1 x Methoxyflurane 3ml ampoule Base - Manual Bag Ventilator Kit - Adult 1 x Manual bag ventilator & filter 1 ea Resus masks Adult sizes 3, 5 1 x Non rebreather mask Adult 1 x PEEP valve Base - Manual Bag Ventilator Kit - Child 1 x Manual bag ventilator & filter 1 ea Resus masks Child sizes 00, 0, 1 1 x Non rebreather mask Child Intensive Care Paramedic IV Drug Roll 15 x Adrenaline (1:1000) 1mg / 1ml 4 x Amiodarone 150mg Inj. 6 x Atropine Sulphate 0.6mg / 1ml 8 x Frusemide 20mg / 2ml 1 x Lignocaine 1% 3 x Ondansetron 4mg / 2ml 2 x Midazolam 15mg / 3ml 3 x Midazolam 5mg / ml 8 x Naloxone 0.4mg / 1ml 2 min Suxamethonium 100mg / 2ml 2 min Vecuronium 10mg powder 5 ea Medication added stickers 2 ea Syringes (1ml, 3ml, 5ml) 4 min Syringe 10ml 1 x Syringe 30ml 6 x Drawing-up needles 2 ea Needles 23g & 25g (sharp) 6 x Saline 10ml ampoules (for injection) 2 ea IV catheter Short 14g, 16g, 18g, 20g, 22g, 24g 4 min IV dressing 3 x Sterile gauze squares (75mm x 75mm) 4 x Luers 1 x Tourniquet 10 min Alcohol swabs 2 x Mucosal atomiser device (MAD) Intubation Roll 1 x Laryngoscope c/w 5 x blades 1 x Lubricant e.g. KY jelly 1 x ET Cobbs connector 1 x Magill forceps Adult 1 x Magill forceps Paediatric 1 min ET introducer Adult & Child 1 min ET holder Adult & Child 1 min ET tubes sizes 3, 4, 5 (non-cuffed) 1 min ET tubes sizes 6, 7, 8, 9 (cuffed) 1 x 2.5cm gauze bandage 1 x 2.5cm tape e.g. Durapore 1 x Syringe 10ml 1 x Safety glasses 1 x Portex bougie 1 x Oesophageal Intubation Detector Quantities of morphine, fentanyl, midazolam and ketamine are also kept on each individual Officer.

why HEMS medical officer of course

Cells and tissues are the hardest part of A&P or so I found, chemistry is completely seperate and should not be included as part since it is a different subject. Are you doing a proper A&P course like ours (which is the same one all other health disclipines have to do) or one of those week long deals for washed up firemonkeys that would barely qualify as generating enough thought to fire up a neuron?

He is obviously distressed but not significantly haemodynamically compromised right now. I'd quickly get an amiodarone drip into him and go with that while starting toward hospital, if the rhythm converts then no further treatment is required. That said, should his blood pressure or haemodynamic state become any worse then I would cardiovert him.

If we can break the rhythm with some amiodarone its less cardiotoxic and invasive than cardioversion. If however, he went down the crapper I'd be giving him the juice therapy pretty quick!

Looks like VT or torsades, hmmm .... start moving toward hospital, get a running IV line into this bloke and give him some amiodarone

We carry everything in a large green thomas pack that doubles as a backpack. There are also some expandable supplies in the vehicle including oxygen masks, IV fluids, an IV roll, glad wrap and general bits and pieces.

California is one of the least progressive states I have seen ... unfortunately little has advanced since the days of Johnny and Roy in the early 1970s. If I have crushing chest pain in Los Angeles I hope I can make it to Phoenix or Portland, seriously. Physician involvement in prehospital medicine as far as the US seems to be concerned is limited to the regulatory requirement for a medical director. Unlike in Europe and some other nations (including here in NZ) the consensus is that there is no need for a physician on scene because the Paramedics learnt everything they need to know down at the six month patch factory and a Doctor is of no help. The US is still mostly based upon the concept you must make contact with a physician to exceed what is generally a rather restrictive standing order (eg 10mg of morphine is not uncommon to be the limit that a Paramedic is able to autonomously administer) and education as well as culture and modalities of clinical praxis reflect it. There is little interest in such things as rapid sequence intubation, advanced combination anaglesia, treat-and-refer, treat-and-leave or requiring education beyond what most other Western nations considered inadequate ten to twenty years ago. In Australia, New Zealand and South Africa it takes four to six years to become an Intensive Care Paramedic (ALS) whereas the same level of practice can be achieved in as little as tweleve weeks in the US.

Look into working aeromedical retrevial / helicopter medical officer rather than working as a Paramedic. HEMS / private air ambulance (interfacility transport) / medivac (repatritisation) jobs are probably your best bet

- Thrombolysis trial - RSI being rolled out nationally - Another 80 FTE Ambulance Officers - Continued phase-out of the Intermediate Care Officer level - Increased numbers of Intensive Care Paramedics - Heartstart MRx replacing LP12s - Ondansetron PO/IV replacing maloxon - Introduction of new Merceedes vehicles (vans) - First full year of CCE - Introduction of new national titles (Emergency Medical Technician, Paramedic and Intensie Care Paramedic) - New CombiCarrer II to replaced old metalic Ferno scoop - Stryker stretchers -

We have unlimited drug dosages (within good clinical reasoning and prudent praxis) and no medical control whatsowever ... never have, never will

Why not go with a jumpsuit like ours?

A thorough knowledge of cardiology, acid/base balance, fluid homeostasis and regulation is essential

Indeed they are; we have Paramedics and Intensive Care Paramedics .... while we do have EMTs they are mainly volunteers and are somewhere between your EMT-B and EMT-I whereas our Paramedics are somewhere between your EMT-I and EMT-P, our Intensive Care Paramedics are somewhere between your EMT P and a CCP. And what are protocols lol we have "guidelines"

Can we please stop this obsession with the hillariously absurd notion (which seems to exist only in America) of dividing patients into "BLS" or "ALS" Thanks!

We generally have two Paramedics (ILS) or one Paramedic and one Intensive Care Paramedic (ALS) There should be at least one person on a vehicle who can interpret an ECG, start a drip and administer at least a basic range of drugs eg adrenaline, salbutamol, GTN, glucose, morphine .... two is better.

Is that crank pipe in your back pocket mate? Our Paramedic faculty have freaking masters or doctoral degrees while Clinical Education staff are highly experienced Paramedic and Intensive Care Paramedics who often have seperate education qualifications. So hmmm, how about not?

Oh dear, this gentleman is quite unwell .... um, could be any of the above

Your new nickname is ...... LOL Weet Bix FTW

Richard, with the upmost respect to your decades of experience .... just because you have a "local protocol" does not mean it is necessarily the best thing to do in the particular case. CPR may or may not be appropriate.

Let me get my credit card ..... Seriously, I do not see a problem with it, its hers to give to whomever she wants

Could always give him a very large dose of ketamine and send him into orbit